ABSTRAK FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN TINGKAT KEPATUHAN BEROBAT PASIEN TB PARU DI RSI BANDUNG DENGAN DOTS DAN RS.MITRA IDAMAN BANJAR TANPA DOTS
Nadia Dara Ayundha 1110179, 2014 Pembimbing I : Dr. J. Teguh Widjaja, dr., SpP., FCCP. Pembimbing II : dr. Hartini Tiono M.Kes Ketidakpatuhan pasien dalam konsumsi obat merupakan masalah kesehatan yang serius dan sering terjadi pada pasien dengan penyakit kronis, seperti penyakit Tuberkulosis Paru (TB Paru). Ketidakpatuhan terhadap pengobatan akan meningkatkan temuan penderita TB paru dengan Basil Tahan Asam (BTA) yang resisten dengan pengobatan standar, meningkatkan risiko penularan, dan kematian. Tujuan penelitian ini adalah untuk mengetahui faktor-faktor yang mempengaruhi tingkat kepatuhan berobat pasien TB Paru di RSI Bandung dengan DOTS dan RS Mitra Idaman Banjar tanpa DOTS. Penelitian ini bersifat Observasional Analitik, yang didapat dengan cara mengisi kuesioner yang berisi 15 pertanyaan mengenai pengetahuan terhadap Tuberkulosis Paru dan tingkat kepatuhan berobat pasien. Sampel pada penelitian ini sebanyak 40 orang. Metode analisis yang digunakan pada penelitian ini adalah Analisis Univarat dan Bivarat. Analisis Bivarat dilakukan dengan uji Fisher’s Exact. Hasil Penelitian diperoleh nilai signifikansi sebesar 0,013. Karena nilai p-value < 0,05, maka H0 ditolak. Didapatkan bahwa terdapat hubungan antara tingkat pengetahuan, tingkat pendidikan dan pendapatan pasien dengan tingkat kepatuhan berobat pasien TB Paru di RSI Bandung dan RS Mitra Idaman Banjar. Simpulan Penelitian menunjukkan bahwa tingkat pengetahuan, tingkat pendidikan dan pendapatan pasien meningkatkan tingkat kepatuhan berobat pasien. Sedangkan, sistem DOTS yang diterapkan oleh Rumah Sakit tidak berpengaruh terhadap tingkat kepatuhan berobat pasien TB Paru di RSI Bandung dan RS Mitra Idaman Banjar. Kata kunci : TB, Pengetahuan, Tingkat Kepatuhan
ABSTRACT THE FACTORS RELATED TO TB ADULT PATIENT OBEDIENCE LEVEL IN MEDICINAL TREATMENT IN IMMANUEL HOSPITAL BANDUNG WITH DOTS AND MITRA IDAMAN HOSPITAL BANJAR WITHOUT DOTS
Nadia Dara Ayundha 1110179, 2014 Advisor I : Dr. J. Teguh Widjaja, dr., SpP., FCCP. Advisor II : dr. Hartini Tiono M.Kes The inobedience patient in consuming medicine is a serious problem and often happen in patient with chronic disease like TB. The inobedience patient in medical treatment will increased TB patient with BTA finding, eventually will increased resistanced standard medical treatment, and morbidity – mortality rate. The Aim of this research was to find factors that influence adult patient obedience level in medical treatment in Immanuel Hospital Bandung with DOTS and Mitra Idaman Hospital Banjar without DOTS. Method of this research was Analytical Observation. 40 subjects filled the Questioner contained 15 questions about TB understanding and patient obedience level. Data analyzed with Bivariat Fisher’s Exact test. Result showed significant result that there is corelation between the level of understanding, degree of education and patient income with TB patient obedience level in medical treatment in Immanuel Hospital Bandung and Mitra Idaman Hospital Banjar. Conclusion level understanding, degree of education and patient income increased patient medical treatment obedience level. Meanwhile, DOTS system which applied in each hospitals did not gave influence in TB patient medical treatment obedience level in Immanuel Hospital Bandung and Mitra Idaman Hospital Banjar. Key Words : TB, Understanding, Obedience Level
DAFTAR ISI Halaman JUDUL ................................................................................................................... i LEMBAR PERSETUJUAN ................................................................................ ii SURAT PERNYATAAN ..................................................................................... iii ABSTRAK ............................................................................................................ iv ABSTRACT ............................................................................................................ v KATA PENGANTAR ......................................................................................... vi DAFTAR ISI ...................................................................................................... viii DAFTAR TABEL ............................................................................................... xi DAFTAR GAMBAR ......................................................................................... xiii DAFTAR LAMPIRAN ..................................................................................... xiv
BAB I PENDAHULUAN 1.1. Latar Belakang .......................................................................................... 1 1.2. Identifikasi Masalah .................................................................................. 3 1.3. Tujuan Penelitian ....................................................................................... 3 1.4. Manfaat Penelitian ..................................................................................... 4 1.4.1 Manfaat Akademis......................................................................... 4 1.4.2 Manfaat Praktis.............................................................................. 4 1.5. Kerangka Pemikiran................................................................................... 4 1.6. Hipotesis...................................................................................................... 5
BAB II TINJAUAN PUSTAKA 2.1 Anatomi Paru-Paru....................................................................................... 6 2.2 Fisiologi Paru-Paru ...................................................................................... 9 2.3 Tuberkulosis............................................................................................... 11
2.3.1 Definisi TB.......................................................................................... 11 2.3.2 Epidemiologi TB................................................................................. 11 2.3.3 Etiologi TB.......................................................................................... 14 2.3.4 Cara Penularan TB .............................................................................. 15 2.3.5 Faktor Risiko TB................................................................................. 16 2.3.6 Klasifikasi TB ..................................................................................... 17 2.3.7 Patogenesis TB.................................................................................... 20 2.3.8 Patofisiologi TB .................................................................................. 22 2.3.9 Gejala Klinik TB ................................................................................. 23 2.3.10 Pemeriksaan Penunjang .................................................................... 24 2.3.11 Pengobatan TB .................................................................................. 27 2.3.11.1 Obat Anti Tuberkulosis (OAT) ................................................... 27 2.3.11.2 Efek Samping Obat ..................................................................... 31 2.3.11.3 DOTS .......................................................................................... 32 2.3.11.4 Evaluasi Pengobatan ................................................................... 33 2.3.12 Komplikasi TB .................................................................................. 34 2.3.13 Pencegahan TB ................................................................................. 34 2.3.14 Prognosis TB..................................................................................... 35 2.4 Pengetahuan .................................................................................................... 35 2.4.1 Faktor yang mempengaruuhi pengetahuan ............................................... 36 2.4.2 Tingkat pengetahuan ................................................................................. 37 2.5 Kepatuhan Pasien ............................................................................................ 38
BAB III METODE PENELITIAN 3.1. Subjek Penelitian ..................................................................................... 41 3.1.1 Kriteria Inklusi dan Eksklusi......................................................... 41 3.2. Tempat dan Waktu Penelitian .................................................................. 41 3.3 Metode Penelitian..................................................................................... 41 3.3.1 Desain Penelitian........................................................................... 41
3.3.2 Instrumen Penelitian...................................................................... 42 3.3.3 Populasi dan Sampel ..................................................................... 42 3.3.4 Definisi operasional variabel......................................................... 42 3.3.4.1 Variabel Terikat................................................... 42 3.3.4.2 Variabel Bebas .................................................... 43 3.4 Pengumpulan Data ..................................................................................... 45 3.5 Prosedur Kerja............................................................................................ 45 3.6 Metode Analisis.......................................................................................... 45 3.7 Aspek Etik Penelitian ................................................................................. 46
BAB IV HASIL, PEMBAHASAN PENELITIAN 4.1. Hasil penelitian.......................................................................................... 47 4.2. Pembahasan............................................................................................... 56
BAB V KESIMPULAN DAN SARAN 5.1. Kesimpulan .............................................................................................. 77 5.2. Saran ......................................................................................................... 77
DAFTAR PUSTAKA .......................................................................................... 67 LAMPIRAN ......................................................................................................... 69 DAFTAR RIWAYAT HIDUP ............................................................................. 84
DAFTAR TABEL
Halaman Tabel 2.1 Segmen Paru – Paru .................................................................................... 7 Tabel 2.2 Perkiraan Jumlah Kasus TB di 3 Negara .................................................... 13 Tabel 2.3 Klasifikasi TB Paru berdasarkan patogenesisnya ....................................... 19 Tabel 2.4 Pengobatan TB berdasarkan kategorinya.................................................... 29 Tabel 2.5 Efek Samping Minor OAT.......................................................................... 31 Tabel 2.6 Efek Samping Mayor OAT ......................................................................... 32 Tabel 4.1 Gambaran Banyaknya Responden Berdasarkan “Jenis Kelamin” di RSI Bandung …………………………………………………………...47 Tabel 4.2 Gambaran Banyaknya Responden Berdasarkan “Jenis Kelamin” di RS Mitra Idaman Banjar..........................................................................48 Tabel 4.3 Gambaran “Kelompok Usia” Responden di RSI Bandung………….........49 Tabel 4.4 Gambaran “Kelompok Usia” Responden di RS Mitra Idaman Banjar…...49 Tabel 4.5 Gambaran “Pendidikan Terakhir” Responden di RSI Bandung………….50 Tabel 4.6 Gambaran “Pendidikan Terakhir” Responden di RS Mitra Idaman Banjar….………………………………………........50 Tabel 4.7 Gambaran “Pekerjaan” Responden di RSI Bandung……………………..51 Tabel 4.8 Gambaran “Pekerjaan” Responden di RS Mitra Idaman Banjar……........52 Tabel 4.9 Gambaran “Pendapatan per bulan” Responden di RSI Bandung………52 Tabel 4.10 Gambaran “Pendapatan per bulan” Responden di RS Mitra Idaman Banjar…………………………………………….54 Tabel 4.11 Gambaran Pengetahuan Responden di RSI Bandung…………….......54 Tabel 4.12 Gambaran Pengetahuan Responden di RS Mitra Idaman Banjar…….55 Tabel 4.13 Gambaran Tingkat Kepatuhan Responden di RSI Bandung………….55
Tabel 4.14 Gambaran Tingkat Kepatuhan Responden di RS Mitra Idaman Banjar…………………………………………...56 Tabel 4.15 Hubungan Pengetahuan Dengan Tingkat Kepatuhan di RSI Bandung………………………………………………………56 Tabel 4.16 Hubungan Sistem DOTS Dengan Tingkat Kepatuhan di RSI Bandung……………………………………………………...57 Tabel 4.17 Hubungan Pendapatan Per Bulan Dengan Tingkat Kepatuhan di RSI Bandung……………………………………………………..58 Tabel 4.18 Hubungan Pendidikan Terakhir Dengan Tingkat Kepatuhan di RSI Bandung……………………………………………………..59 Tabel 4.19 Hubungan Pengetahuan Dengan Tingkat Kepatuhan di RS Mitra Idaman Banjar……………………………………........60 Tabel 4.20 Hubungan Sistem DOTS Dengan Tingkat Kepatuhan di RS Mitra Idaman Banjar……………………………………........61 Tabel 4.21 Hubungan Pendapatan Per Bulan Dengan Tingkat Kepatuhan di RS Mitra Idaman Banjar……………………………………........63 Tabel 4.22 Hubungan Pendidikan Terakhir Dengan Tingkat Kepatuhan di RS Mitra Idaman Banjar……………………………………........64
DAFTAR GAMBAR
Halaman Gambar 2.1 Segmen Paru kanan ........................................................................... 8 Gambar 2.2 Segmen Paru kiri ............................................................................... 9 Gambar 2.3 Pembuluh darah Paru ...................................................................... 10 Gambar 2.4 Persarafan Paru................................................................................ 10 Gambar 2.5 Insidensi TB di dunia ..................................................................... 14
DAFTAR LAMPIRAN Halaman LAMPIRAN 1
Surat Persetujuan Komisi Etik Penelitian .............................. 77
LAMPIRAN 2
Informed Consent .................................................................... 78
LAMPIRAN 3
Kuesioner Penelitian ............................................................... 80
